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� EE:RECIF D SAN JOAQUIN COUNTY HD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> OCT 3 al' 2015 1868 East Hazelton Avenue,.Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERfAIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> 1r /- <br /> APPLICANT: C�f6-14 vk. /l`JCtc-ti BUSINESSIAGENCY: <br /> ADDRESS: Z(vl5 Zatc�, (c rCITY/STATE/ZIP: / � >� 104 ys � <br /> PHONE (1): f'z5~ f �� �� PHONE(2): <br /> FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 F-E(CA R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,/ -- --- DATE <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> lS/treet# Street Name City <br /> lr'�C" <br /> 2. 1 nit 1 <br /> 3. <br /> o o ( [] .nit 2 <br /> 4. Wt 2H �� I <br /> 6. I � <br /> �)"��� (] Unit3 <br /> 7. Ddnit 4 <br /> 8' LUTE MITIGATION <br /> 9. <br /> 110. I I (].'Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTA"EALTH DEPARTMENT FILES <br /> Q EUN -SOLID WASTE FACILITYNEHICLE <br /> r,U <br /> iHER CLEANUP SITE(NOi�-LOP) I/1IiOUSING ABAT-HENT ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) -FOOD FACILITY ❑DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WAST WATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑BUMPER TRUCKNARDICHEMICAL TOILETS <br /> F1TIERED PERMITTED FACILITY E]POOLISPA [1]LAND"USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING Q-COMPLAINTIRESPONSE RECORDS ©OTHER(PLEASE SPECIFY) 7` Vt <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 0.0t,Uk, 1400VAP Nei, (of (x -10 -t. a'e- q G _ JUC! '.+n r ('4;L0 <br /> ❑ Records provided by Sta l-PPR Complete. Staff Name: <br /> EHD 48.06 711/15 <br />